Provider Demographics
NPI:1174689863
Name:WANGAN, BRET PAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:PAUL
Last Name:WANGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 GOLDEN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6287
Mailing Address - Country:US
Mailing Address - Phone:530-621-7322
Mailing Address - Fax:530-621-7707
Practice Address - Street 1:970 RESERVE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1376
Practice Address - Country:US
Practice Address - Phone:916-780-1070
Practice Address - Fax:916-780-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health